Perioperative mortality of emergency and elective surgical cases at a low-resource hospital in Papua New Guinea: a retrospective study at Kimbe Provincial Hospital

Background Perioperative mortality rate is one of the six core indicators for monitoring access to safe surgery and anaesthesia by providing broader insight into perioperative processes, including patient selection, referral pathways, anaesthetic capacity, postoperative monitoring, and critical care availability. This study aims to determine the perioperative mortality rates for emergency and elective surgical procedures performed at Kimbe Provincial Hospital in Papua New Guinea and to identify the major clinical and system-related factors associated with perioperative mortality in this low-resource setting. Method A retrospective descriptive study was conducted over a period of 6 years, from January 2020 to December 2025. The study included all paediatric and adult patients who underwent operative procedures within the 6 years in Kimbe Provincial Hospital operating theateres. Data analysis was performed using Microsoft Excel 2013. Result Over the 6-year period, a total of 7939 patients underwent operative procedures. Elective procedures accounted for 5109 cases (64.36%), while emergency procedures accounted for 2830 cases (35.64%). A total of 72 perioperative deaths were recorded with an overall perioperative mortality rate (POMR) of 0.91%. There were 46 male deaths (63.89%) and 26 female deaths (36.11%). General surgery accounted for the majority of perioperative deaths (n = 47, 65.28%) with higher mortality in emergency procedures (n = 41, 56.94%). Emergency POMR consistently exceeded elective POMR, with a cumulative emergency POMR of 1.45%, more than double the elective POMR of 0.61%. The most common diagnosis associated with perioperative mortality were diabetic foot infections and necrotising soft tissue infections (n = 25, 34.72%), with sepsis or septic shock (51.39%) the leading cause of perioperative deaths. Conclusion Our evidence is consistent with other similar studies in low- and middle-income countries, were POMR is high in emergency procedures. Sepsis, delayed presentation, and limited perioperative critical care capacity were major contributors to mortality.